Independence at Home

The Senate Finance Committee has unanimously approved a bill aimed at improving care for Medicare beneficiaries with chronic conditions.

Med Page Today reports that the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017 {whew!} would increase access to telehealth for Medicare beneficiaries with chronic illnesses — including those in Medicare Advantage plans — as well as provide more incentives for enrollees to receive care through accountable care organizations (ACOs). It also would extend the Independence at Home demonstration program to keep people in their homes rather than hospitals, allow reimbursement for more non-health and social services, and extend permanently MA Special Needs plans that target chronically ill beneficiaries.”

“One thing we hear a lot from ACOs is they have trouble keeping beneficiaries in-house rather than going to a provider outside the ACO, and that makes it harder to coordinate their care,” a committee aide told the publication. “This bill says that if you go to a primary care doctor in the ACO, we’ll reduce or eliminate your cost-sharing for that primary care service. That will make beneficiaries stick to the ACO, and bring down their costs.”

“This is a formal recognition that this package of services — the focus on care at home, the focus on new technology, the expanded role for primary care and prevention, which inevitably leads to more non-physician providers — is the beginning of our push to update the Medicare guarantee. That’s why it’s transformative.”

MedCity News looks at Independence at Home, a Medicare experiment involving that old-fashioned thing called house calls, aimed at cutting costs and improving care.

MedCity says that in the first year of the experiment, “Housecall Providers of Portland, Ore., which had been operating at a loss, saved Medicare an average of almost $13,600 for each patient in the pilot project. Its share of the savings was $1.2 million. The house calls practice at MedStar Washington Hospital, in Washington, D.C., cut the cost of care an average of $12,000 per patient.”
“Medicare reported overall savings of $25 million in the pilot’s first year, officials reported last June. From that money, nine practices earned bonuses totaling nearly $12 million, including a $2.9 million payment to a practice in Flint, Mich.”

“After three practices dropped out, there are now 14 around the country participating in the project — including five sites run by the Visiting Physicians Association.”

Medicare officials are expected to announce the second round of payments in the program next month.